Kevin Allen Skidmore, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

1913DT Issued in KY

Practice address

854 Ridgewood Drive
Berea, KY 40403

Phone

(859) 986-7027

Fax

(859) 986-4749

NPI assigned

Jul 16, 2012

Last updated

Sep 17, 2020By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in KY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

Ohio State University - College of Optometry, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Dr. Gary E. King Optometrist PSCGroup PAC ID 8628138229, 5 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Dr. Gary E. King Optometrist PSC

  • Clinic/Center
  • Berea, KY
  • NPI 1588819080
  Medicare reassignment Care Compare group NPD
• Helderman & Jacobs Vison Center, PLLC

  • Durable Medical Equipment & Medical Supplies
  • Mt Sterling, KY
  • NPI 1659420602
  NPD (past)
• Kentucky Institute for Eye Health & Surgery

  dba Kentucky Eye Institute

  • Durable Medical Equipment & Medical Supplies
  • Middlesboro, KY
  • NPI 1013015510
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1342396800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600300800000",
    "number": "1093060188",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "854 RIDGEWOOD DRIVE",
            "city": "BEREA",
            "state": "KY",
            "postal_code": "40403",
            "telephone_number": "859-986-7027",
            "fax_number": "859-986-4749"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "854 RIDGEWOOD DRIVE",
            "city": "BEREA",
            "state": "KY",
            "postal_code": "40403",
            "telephone_number": "859-986-7027",
            "fax_number": "859-986-4749"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SKIDMORE",
        "first_name": "KEVIN",
        "middle_name": "ALLEN",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-07-16",
        "last_updated": "2020-09-17",
        "certification_date": "2020-09-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OH",
            "license": "OPT.6159-THER",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "KY",
            "license": "1913DT",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Leslie Ann Short, LMT
• Sipple & Sipple Chiropractic (Sipple's Chiropractic)
• Brandon Sipple, D.C.
• John Christopher Sipple, D.C.
• John Daniel Sipple, D.C.
• Smile Revival LLC
• Matthew Alan Smith, MSPT
• Robin Kay Smith, APRN
• Sara Jane Smith, PHARM. D.
• Nawar Soda, MD

• Optometrist in Berea, KY
• Providers in Berea, KY by specialty
• Optometrist in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.